@article{6e8a683515f947dca7643e754c19a04f,
title = "Natality decline and spatial variation in excess death rates during the 1918–1920 influenza pandemic in Arizona, United States",
abstract = "A large body of epidemiologic research has concentrated on the 1918 influenza pandemic, but more work is needed to understand spatial variation in pandemic mortality and its effects on natality. We collected and analyzed 35,151 death records from Arizona for 1915–1921 and 21,334 birth records from Maricopa county for 1915–1925. We estimated the number of excess deaths and births before, during, and after the pandemic period, and we found a significant decline in the number of births occurring 9–11 months after peak pandemic mortality. Moreover, excess mortality rates were highest in northern Arizona counties, where Native Americans were historically concentrated, suggesting a link between ethnic and/or sociodemographic factors and risk of pandemic-related death. The relationship between birth patterns and pandemic mortality risk should be further studied at different spatial scales and in different ethnic groups.",
keywords = "1918–1920, Arizona, Birth, Excess mortality, Influenza pandemic, Maricopa county, Natality",
author = "Sushma Dahal and Kenji Mizumoto and Robert Bolin and C{\'e}cile Viboud and Gerardo Chowell",
note = "Funding Information: S.D. acknowledges support from the Fulbright program. This work was funded by the Japanese Society for the Promotion of Science (grants 15K20936 and 18K17368 to K. M.); the Program for Advancing Strategic International Networks to Accelerate the Circulation of Talented (grant G2801 to K. M.); the Multinational Influenza Seasonal Mortality Study (http://www.misms.net), Fogarty International Center, National Institutes of Health (support to G.C. and C.V.); the RAPIDD Program, Science and Technology Directorate, Department of Homeland Security (support to G.C. and C. V.); the National Science Foundation (grant 1414374 to G. C.), as part of the joint National Science Foundation–National Institutes of Health–US Department of Agriculture Ecology and Evolution of Infectious Diseases program; and the United Kingdom Biotechnology and Biological Sciences Research Council (grant BB/M008894/1). This work does not represent the views of the US Government or the National Institutes of Health. Conflict of interest: none declared. Publisher Copyright: {\textcopyright} American Society for Clinical Pathology, 2018. All rights reserved.",
year = "2018",
month = dec,
day = "1",
doi = "10.1093/aje/kwy146",
language = "English (US)",
volume = "187",
pages = "2577--2584",
journal = "American journal of epidemiology",
issn = "0002-9262",
publisher = "Oxford University Press",
number = "12",
}